Seniors health insurance

Life is unexpected. While we may eat a well-balanced diet and exercise regularly, we are more susceptible to certain ailments as we age. With the right level of cover, seniors health insurance takes the financial burden off your shoulders should you fall ill or become injured, and helps you enjoy the life you’ve worked so hard for.

Having hospital cover and tying in a selection of extras that relate to your unique situation will put you in good stead to get the most out of your private health fund.

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What is seniors health insurance?

Health insurance policies designed for seniors are suitable for both singles and couples who are 65 years and older, and helps pay for your healthcare expenses in and out of hospital as you age. These policies vary depending on your current and future needs.

Why is health insurance for seniors so important?

When it comes to waiting lists for important surgeries, health insurance can help you get back to your day-to-day activities much faster.

For instance, if you don’t have health insurance and were to injure your hip and require hip replacement surgery, you would be placed on a waiting list that could take a couple of years in the public system.

This is likely if you live in a busy city or in a remote area. However, if you have the right level of cover, you may only need to wait a few short months (provided you have served your waiting periods) to get the problem fixed, undergo recovery, and continue to enjoy life’s adventures.

What does health insurance for seniors cover?

Seniors can choose a health insurance policy that is tailored to their current and future needs. All in all, these policies are more effective if they cover common senior health implications, like cancer, gum disease, heart disease, and hip and knee replacements, as well as any services you believe may be helpful later in life.

Policies can include hospital cover, hospital and extras cover, or extras only cover. You may wish to consider some of the following inclusions (once you have served your waiting periods):

Private hospital cover
Extras

Be admitted as a private patient, choose your own doctor, stay in a private hospital, and enjoy greater flexibility in scheduling your medical procedures.

Heart surgery, including bypass surgery, angiograms, and stents.
Joint replacement, including surgery and replacement of joints.
Major eye surgery, including cataract surgery.
In-hospital rehabilitation and psychiatry.
Palliative care.

These policies subsidise out of hospital care that would have otherwise cost hundreds, perhaps thousands of dollars.

Optical, which includes some cover for prescribed glasses and contact lenses.
Physiotherapy, which is designed to restore proper body function and reduce permanent disease or injury through exercise programs, manual therapies, and electrotherapy techniques.
Remedial massage to treat certain injuries and encourage recovery, and; chiropractic, which treats health issues related to nerves, muscles, and skeletons.
Acupuncture, where small needles are inserted into specific points in the body to stimulate nerve pulses and recovery.
Podiatry and orthotics.
Psychology, which is designed to help those with mental and physical health. Some general treatment policies offer benefits for this service.
Speech therapy, including benefits paid towards the treatment of stroke victims.
Hearing aids, including design, repair, and replacement.
Dietetics.
Health aids and appliances, like glucose monitors, crutches, and blood pressure monitors.

Be sure you carefully check the Product Disclosure Statement (PDS) with each policy, as you could be (or are being) charged for redundant inclusions, like birth-related services (i.e. obstetrics), and assisted reproduction, like IVF. Compare the Market can help you compare and decide on the health insurance policy that covers your needs. Don’t worry; you won’t have to re-serve any waiting periods you’ve already honoured.

What isn’t covered by health insurance that might affect seniors?

Private health insurance does not cover aged care; eligible seniors can gain access to partially government-funded aged care to help lower costs. Depending on the type of policy, there may be other exclusions as well, some including:

visits to your GP
eye exams, as they are subsidised by Medicare
certain services like elective cosmetic surgery and laser eye surgery are either not covered or are covered to a limited amount. The same applies to some other services that aren’t listed under the Medicare Benefits Schedule (MBS).

How much can health insurance for seniors cost?

The cost of health insurance depends on the type of coverage you select. As you can deduct certain redundant services like family-planning, coverage can be cheaper than some family or couples policies. And if you’re an empty-nester, you might like to switch to a suitable couples or singles health insurance policy.

Seniors over 65 receive a higher government rebate on health insurance than younger policyholders to help cover the cost of premiums. As outlined in the table below, the standard rebate amount is around 31% for singles over 65 years old earning $90,000 or less, or families over 65 years old earning $180,000 or less. The standard rebate on health insurance for seniors over 70 is greater again, and is applied approximately at a rate of 36%. For more rebate rates versus income thresholds, take a look at the table below:

Earning thresholds
Singles	< 90,000		90,001 – 105,000			105,001 – 140,000		> 140,001
Families	< 180,000		180,000 -210,001			210,001 – 280,000		>280,001
Rebate percentage
Age		Standard		Tier one	Tier two		Tier three
< 65		26.791%		17.861%	8.930%		0%
65 – 69		31.256%		22.326%	13.395%		0%
70 >		35.722%		26.791%	17.861%		0%
Medicare Levy Surcharge
All ages		0.0%		1.0%	1.25%		1.5%

N.B. These rebate levels are applicable from 1 April 2017 to 31 March 2018. Families include single parents, couples, and de facto couples.You may be eligible for a private health insurance rebate if you:

are eligible for Medicare
have a complying health insurance product (either extras or hospital cover)
have an income below Tier Three for Medicare Levy Surcharge purposes.

Additional costs

Lifetime Health Cover (LHC), introduced in July 2000, is a financial loading that is an added cost to anyone over the age of 31 if they haven’t held continuous hospital cover and decide to take it out (provided they are not exempt).This loading is charged on top of your hospital premium at 2% for each year you are over 30 if you didn’t purchase hospital cover before July 1 following your 31^st birthday or July 1, 2000, or if you have not held hospital cover for the past 10 years. This rate is capped at a maximum of 70%, and is removed once you have held and paid the LHC loading for 10 years. See how you’re affected by LHC by using our handy LHC calculator.The Medicare Levy Surcharge (MLS) can be charged up to 1.5% to high income earner (families earning $180,000 per year or childless individuals earning more than $90,000 annually) that don’t hold hospital cover. This is not to be confused with the Medicare Levy, which applies to all taxpayers, as the MLS is charged on top of the levy. So if you’re still working, or are earning money from investments, seniors health insurance can help prevent this added cost.Frequently asked questions

Does it cost more for seniors to get covered?

Seniors are not required to pay more to obtain the same level of private health insurance as a younger individual.

Why? Private health insurance is community rated, which means everyone, no matter their age or condition, is able to purchase the same policy at the same price, and have the right to renew their policy. The exception here is Lifetime Health Cover (LHC), where you’re required to pay a higher premium if you attract LHC loading.

On top of this, health funds cannot deny policies to certain people based on their health or the likelihood of claiming on certain services.

What is pre-existing condition?

A pre-existing health condition is any illness, ailment, or condition that you had signs or symptoms of in the six-month period before you took out a policy, or upgraded to a higher level of cover (which may or may not have been diagnosed by your doctor at the time). There is usually a twelve-month waiting period for pre-existing conditions, with the exception of rehabilitation, psychiatric, or palliative care, where there is a two month wait.

Visit pre-existing health conditions for more information

What If I Have Pre-Existing Conditions?

That’s completely fine. In most cases you can still include extras and hospital benefits in your cover that relate to your conditions at no extra premium, though, the only limitation is the waiting period. Once you have served the relevant waiting period, you will receive the full benefit associated with the condition – as long as it is covered by the policy, of course.

Why are there waiting periods and how long are they?

Waiting periods prevent people from claiming on certain parts of their health insurance policy. Without them, someone could sign up, claim on an expensive treatment, and then cancel after receiving their benefit – without paying anything substantial on their policy. This type of behaviour would disadvantage other members, and would result in increased premiums for all fund members.

Standard waiting periods for hospital cover are as follows:

12 months for pre-existing conditions, except where these are related to psychiatric care, rehabilitation, or palliative care, where the period is two months
12 months for obstetrics (pregnancy)
two months in all other circumstances.

The waiting periods for extras policies are set by individual funds. Make sure you are fully aware of all the waiting periods you may have to serve.

What doesn't Medicare pay for?

Medicare covers around 75% of the Medicare Benefits Schedule (MBS) fee, and the right private health insurance policy covers the remaining 25% of the MBS fee if you’re treated as a private patient in a public or private hospital.

Certain medical or hospital charges may exceed what you can claim back from Medicare or your health insurance – this is known as the ‘gap’. To help with some of these out-of-pocket expenses, some health funds offer gap cover by making arrangements and agreements with many hospitals and particular doctors.

Some services Medicare doesn’t cover include:

hospital costs for private patients
cosmetic surgery
ambulance services
most dental examinations
acupuncture
home nursing
glasses and contact lenses
hearing aids
the majority of physiotherapy, chiropractic, podiatry, and psychology services.

How can you get covered?

Ensure your golden years shine bright with the correct level of health insurance. Chat to Compare the Market’s friendly consultants to help you find the best health insurance plan to suit your budget and lifestage.